title: Effectiveness of leech therapy in chronic lateral epicondylitis: a randomized controlled trial.
abstract: OBJECTIVE
  Leech therapy has been found to be effective in osteoarthritis of the knee and hand in previous trials. Chronic epicondylitis is a prevalent pain syndrome with limited treatment options. In this study, we tested whether leech therapy would be beneficial in the symptomatic treatment of chronic lateral epicondylitis.
  
  
  METHODS
  Forty patients with manifestation of epicondylitis of at least 1-month duration were randomized to a single treatment with 2 to 4 locally applied leeches or a 30-day course with topical diclofenac. The primary outcome was change of pain sum score on day 7 calculated from 3 visual analog scales for pain during motion, grip, and rest. Secondary outcomes included disability (Disability of the Arm, Shoulder, Hand questionnaire), physical quality of life (Short Form-36), and grip strength. Outcomes and safety were assessed on days -3, 0, 7, and 45.
  
  
  RESULTS
  Leeches induced a significantly stronger decrease of the pain score (143.7±36.9 to 95.3±45.1) compared with topical diclofenac (131.6±29.6 to 134.7±70.7; mean difference -49.0; 95% confidence interval,-82.9--15.1; P=0.0075) after 7 days. On day 45, this group difference was reduced (-27.5; confidence interval, -60.8-5.8; P=0.110) due to delayed pain relief with diclofenac. Functional disability showed a stronger decrease in the leech group, which was most prominent after 45 days (P=0.0007). Quality of life increased nonsignificantly in the leech group. Results were not affected by outcome expectation.
  
  
  CONCLUSIONS
  A single course of leech therapy was effective in relieving pain in the short-term and improved disability in intermediate-term. Leeches might be considered as an additional option in the therapeutic approach to lateral epicondylitis.
authors.affiliation: Department of Internal and Integrative Medicine, Kliniken-Essen-Mitte, Essen, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bäcker
authors.forename: Rainer
authors.initials: R
authors.lastname: Lüdtke
authors.forename: Dani
authors.initials: D
authors.lastname: Afra
authors.forename: Ozgur
authors.initials: O
authors.lastname: Cesur
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Matthias
authors.initials: M
authors.lastname: Fink
authors.forename: Jürgen
authors.initials: J
authors.lastname: Bachmann
authors.forename: Gustav J
authors.initials: GJ
authors.lastname: Dobos
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
mesh_terms: D002908:Chronic Disease; D005260:Female; D006801:Humans; D024763:Leeching / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D013716:Tennis Elbow / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome